Tuesday, November 25, 2014
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Arthritis: What are my options?

Arthritis is the single greatest challenge in orthopedics--but there are no shortage of potential treatments.

Arthritis: What are my options?

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Arthritis is the biggest challenge in orthopaedics. But what is it and how can we treat it? 

By definition, arthritis means joint inflammation: arth=joint, itis= inflammation. Arthritis is simply damage to the joint surface cartilage and the adjacent structures. This can be from trauma, years of use or overuse, or simply from genetics and inheriting less durable cartilage.

Arthritis is a spectrum of damage from mild changes that produce no symptoms to advanced disease that causes severe pain and functional limitations. Can we cure arthritis?  The process of gradual deterioration cannot be “cured” but the discomfort that results can be treated and in some cases the progression can be delayed. Once arthritis is severe it can be “cured” with joint replacement surgery. Let’s discuss the options, both conservative and surgical, and show what works and what doesn’t.

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There are numerous supplements touted for their ability to treat arthritis such as shark cartilage, devil’s claw, and egg shell membrane. Since supplements are not controlled by the FDA, they can pretty much say whatever they want without any evidence to support their claims.

So, which supplements show positive benefits for the treatment of arthritis? 1,500 mg of Glucosamine sulfate and up to 1200mg of chondroitin has shown some benefit in arthritis symptoms after 4-8 weeks of use. Omega 3 fatty acids (found in fish oil or flaxseed oil) have produced symptomatic relief for osteoarthritis according to some research studies.

Exercise

Moderate exercise has been shown to decrease symptoms and increased function in patients with mild to moderate arthritis. The goals of exercise are to maintain and/or improve range of motion and strength. The key is not to perform exercises that cause increased symptoms, which may be difficult in people with more advanced arthritis. The general rule of thumb is: don’t do exercises that result in pain lasting for more than an hour after you are finished exercising or that produce pain that keeps you awake at night. So with joint damage, “no pain, no gain” does not apply.

Non-steroidal Anti-inflammatories

Anti-inflammatory medications decrease inflammation and thereby decrease pain and swelling associated with arthritis. NSAIDs play a major role in the treatment of arthritis symptoms. Long term use can pose both GI and cardiovascular problems so make sure you check with your physician even when taking over the counter medication.

Corticosteroids

Corticosteroid injections can provide short term (3-6 month) relief in symptoms for many patients with osteoarthritis. Although some people are concerned about the long term complications of these injections, there is no significant evidence to show that they advance the progression of arthritis. Injections don’t work for everyone and most doctors recommend a maximum of two or three injections per year.

Viscosupplementation

Viscosupplementation treatments involve injecting hyaluronic acid (HA) into the knee. HA is the natural lubrication that the body makes in joints to provide lubrication. These injections stimulate your body to produce normal synovial fluid, a component is HA, which can help with symptoms as well as possibly slow the progression of arthritis. The research is mixed on its effectiveness. These injections are done every six months and are covered by insurance. Depending on the brand, they can be a single shot or multiple injections with as many as five over a five week period.

PRP

PRP (platelet rich plasma) injections involve taking a small amount of your own blood, spinning it down, and injecting the platelets back into the problematic area. To date, there is no hard evidence showing the effectiveness for the treatment of arthritis. However, there are case studies that show benefit as well as anecdotal evidence. There is low risk with the procedure but it is not covered by insurance and can be fairly costly, ranging from $350 to over $1000 per injection with most treatments consisting of three injections over three weeks.

Prolotherapy

Otherwise known as proliferative or regenerative therapy, prolotherapy involves injecting an irritant or inflammatory material in to the body to stimulate the body’s own healing process. Again results are mixed and hard scientific proof of effectiveness is lacking.

Stem Cells

To date, there is a lack of clinical trials regarding the use of stem cells for the treatment of osteoarthritis. Basic science studies show the potential role of stem cells and some success has been reported in treating arthritis but further evidence is needed. And as with PRP injections, stem cell treatment is not covered by insurance and can be cost prohibitive for most patients.

Arthroscopy

Arthroscopic surgery for the symptoms of aching and swelling associated with osteoarthritis has mixed results. It is most effective for pain that includes catching and locking. One research study showed that placebo surgery was as effective as the actual procedure itself. I use the rule of thirds for arthroscopy as a remedy forarthritis. A third get better, a third stay the same, and a third will continue to get worse despite surgical intervention. Make sure to ask your physician what the expected outcome is before considering arthroscopic surgery.

Joint Replacement

When conservative measures fail and quality of life is suffering, joint replacement surgery can be a cure for the problem. Joint replacement actually fixes the arthritis by removing all of the diseased cartilage and resurfacing the joint. Joint replacement is most effective in people with severe disabling pain and those people who are willing to modify their activities with the surgery having a 75-90% success rate.

Joint replacement is not for the person who has minor achy discomfort with activities or for the person who wants to get back to life as a 20-year-old.One must meet certain criteria to be a candidate and have realistic expectations following surgery. You’re not going to run a marathon afterwards but 18 holes of golf and doubles tennis is totally realistic.

Everyone knows someone whose life is affected in some way by arthritis. It is a disease process that presently has no cure. There are many treatments on the market today that provide substantial pain relief. The best treatment approach involves modifying activity, maintaining a healthy lifestyle, keeping your weight under control, and not rushing into surgery unless conservative management has failed.


Read more Sports Doc for Sports Medicine and Fitness.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Martin J. Kelley, PT, DPT, OCS Advanced Clinician at Penn Therapy and Fitness, Good Shepherd Penn Partners
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Health Producer, Philly.com
Tracey Romero Sports Medicine Editor, Philly.com
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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